BackgroundCervical cancer and infection with human immunodeficiency virus HIV are both important public health problems in South Africa SA. The aim of this study was to determine the prevalence of cervical squamous intraepithelial lesions SILs, high-risk human papillomavirus HR-HPV, HPV viral load and HPV genotypes in HIV positive women initiating anti-retroviral ARV therapy.

MethodsA cross-sectional survey was conducted at an anti-retroviral ARV treatment clinic in Cape Town, SA in 2007. Cervical specimens were taken for cytological analysis and HPV testing. The Digene Hybrid Capture 2 HC2 test was used to detect HR-HPV. Relative light units RLU were used as a measure of HPV viral load. HPV types were determined using the Roche Linear Array HPV Genotyping test. Crude associations with abnormal cytology were tested and multiple logistic regression was used to determine independent risk factors for abnormal cytology.

ResultsThe median age of the 109 participants was 31 years, the median CD4 count was 125-mm, 66.3% had an abnormal Pap smear, the HR-HPV prevalence was 78.9% Digene, the median HPV viral load was 181.1 RLU HC2 positive samples only and 78.4% had multiple genotypes. Among women with abnormal smears the most prevalent HR-HPV types were HPV types 16, 58 and 51, all with a prevalence of 28.5%. On univariate analysis HR-HPV, multiple HPV types and HPV viral load were significantly associated with the presence of low and high-grade SILs LSIL-HSIL. The multivariate logistic regression showed that HPV viral load was associated with an increased odds of LSIL-HSIL, odds ratio of 10.7 95% CI 2.0 – 57.7 for those that were HC2 positive and had a viral load of ≤ 181.1 RLU the median HPV viral load, and 33.8 95% CI 6.4 – 178.9 for those that were HC2 positive with a HPV viral load > 181.1 RLU.

ConclusionWomen initiating ARVs have a high prevalence of abnormal Pap smears and HR-HPV. Our results underscore the need for locally relevant, rigorous screening protocols for the increasing numbers of women accessing ARV therapy so that the benefits of ARVs are not partially offset by an excess risk in cervical cancer.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-9-275 contains supplementary material, which is available to authorized users.